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Lasers in Medical Science

, Volume 32, Issue 4, pp 953–963 | Cite as

Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review

  • Valerie G. A. Suter
  • Sophia Sjölund
  • Michael M. Bornstein
Review Article

Abstract

The aim of this systematic review was to assess a potential benefit of laser use in the treatment of recurrent aphthous stomatitis (RAS). The primary outcome variables were pain relief, duration of wound healing and reduction in episode frequency. A PICO approach was used as a search strategy in Medline, Embase and Cochrane databases. After scanning and excluding titles, abstracts and full texts, 11 studies (ten RCTs and one non-randomised controlled trial) were included. Study selection and data extraction was done by two observers. Study participants varied between 7–90 for the laser and 5–90 for the control groups. Laser treatment included Nd:YAG laser ablation, CO2 laser applied through a transparent gel (non-ablative) and diode laser in a low-level laser treatment (LLLT) mode. Control groups had placebo, no therapy or topical corticosteroid treatment. Significant pain relief immediately after treatment was found in five out of six studies. Pain relief in the days following treatment was recorded in seven studies. The duration of RAS wound healing was also reduced in five studies. However, criteria of evaluation differed between the studies. The episode frequency was not evaluated as only one study addressed this outcome parameter, but did not discriminate between the study (LLLT) and control (corticosteroid) groups. Jadad scores (ranging from 0 to 5) for quality assessment of the included studies range between 0 and 2 (mean = 1.0) for studies analysing pain relief and between 0 and 3 (mean = 1.1) for studies evaluating wound healing. The use of lasers (CO2 laser, Nd:YAG laser and diode laser) to relieve symptoms and promote healing of RAS is a therapeutic option. More studies for laser applications are necessary to demonstrate superiority over topical pharmaceutical treatment and to recommend a specific laser type, wavelength, power output and applied energy (ablative versus photobiomodulation).

Keywords

Aphthous ulcer CO2 laser Diode laser Nd:YAG laser Low-level laser Photobiostimulation Photobiomodulation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Funding

The study was funded by departmental funds of the Department of Oral Surgery and Stomatology, University of Bern.

Ethical approval

Ethical approval was not needed for this systematic review.

Informed consent

Informed consent was not needed for this systematic review.

References

  1. 1.
    Zain RB (2000) Oral recurrent aphthous ulcers/stomatitis: prevalence in Malaysia and an epidemiological update. J Oral Sci 42:15–19CrossRefPubMedGoogle Scholar
  2. 2.
    Chattopadhyay A, Shetty KV (2011) Recurrent aphthous stomatitis. Otolaryngol Clin North Am 44:79–88CrossRefPubMedGoogle Scholar
  3. 3.
    Axéll T, Henricsson V (1985) The occurrence of recurrent aphthous ulcers in an adult Swedish population. Acta Odontol Scand 43:121–125CrossRefPubMedGoogle Scholar
  4. 4.
    Davatchi F, Tehrani-Banihashemi A, Jamshidi AR, Chams-Davatchi C, Gholami J, Moradi M, Akhlaghi M, Foroozanfar MH, Barghamdi M, Noorolahzadeh E, Samadi F, Hadj-Aliloo M, Ghaznavi K, Ghaznavi K, Soroosh M, Khabazi A, Salari AH, Sharif SK, Karimifar M, Salessi M, Essalat-Manesh K, Nadji A, Shahram F (2008) The prevalence of oral aphthosis in a normal population in Iran: a WHO-ILAR COPCORD study. Arch Iran Med 11:207–209PubMedGoogle Scholar
  5. 5.
    McCullough MJ, Abdel-Hafeth S, Scully C (2007) Recurrent aphthous stomatitis revisited; clinical features, associations, and new association with infant feeding practices? J Oral Pathol Med 36:615–620CrossRefPubMedGoogle Scholar
  6. 6.
    Slebioda Z, Szponar E, Kowalska A (2014) Etiopathogenesis of recurrent aphthous stomatitis and the role of immunologic aspects: literature review. Arch Immunol Ther Exp (Warsz) 62:205–215CrossRefGoogle Scholar
  7. 7.
    Al-Omiri MK, Karasneh J, Alhijawi MM, Zwiri AM, Scully C, Lynch E (2015) Recurrent aphthous stomatitis (RAS): a preliminary within-subject study of quality of life, oral health impacts and personality profiles. J Oral Pathol Med 44:278–823CrossRefPubMedGoogle Scholar
  8. 8.
    Truelove SC, Morris-Owen RM (1958) Treatment of aphthous ulceration of the mouth. BMJ 15:603–607CrossRefGoogle Scholar
  9. 9.
    Cook BE (1960) The diagnosis of bullous lesions affecting the oral mucosa. I. Br Dent J 109:83–96PubMedGoogle Scholar
  10. 10.
    Scully C, Porter S (2008) Oral mucosal disease: recurrent aphthous stomatitis. Br J Oral Maxillofac Surg 46:198–206CrossRefPubMedGoogle Scholar
  11. 11.
    Jurge S, Kuffer R, Scully C, Porter SR (2006) Mucosal disease series. Number VI. Recurrent aphthous stomatitis. Oral Dis 12:1–21CrossRefPubMedGoogle Scholar
  12. 12.
    Chavan M, Jain H, Diwan N, Khedkar S, Shete A, Durkar S (2012) Recurrent aphthous stomatitis: a review. J Oral Pathol Med 41:577–583CrossRefPubMedGoogle Scholar
  13. 13.
    Baccaglini L, Lalla RV, Bruce AJ, Sartori-Valinotti JC, Latortue MC, Carrozzo M, Rogers RS 3rd (2011) Urban legends: recurrent aphthous stomatitis. Oral Dis 17:755–770CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Graykowski EA, Barile MF, Lee WB, Stanley HR Jr (1966) Recurrent aphthous stomatitis. Clinical, therapeutic, histopathologic, and hypersensitivity aspects. JAMA 196:637–644CrossRefPubMedGoogle Scholar
  15. 15.
    Koybasi S, Parlak AH, Serin E, Yilmaz F, Serin D (2006) Recurrent aphthous stomatitis: investigation of possible etiologic factors. Am J Otolaryngol 27:229–232CrossRefPubMedGoogle Scholar
  16. 16.
    Taylor J, Glenny AM, Walsh T, Brocklehurst P, Riley P, Gorodkin R, Pemberton MN (2014) Interventions for the management of oral ulcers in Behçet’s disease. Cochrane Database Syst Rev 9:CD011018Google Scholar
  17. 17.
    Belenguer-Guallar I, Jiménez-Soriano Y, Claramunt-Lozano A (2014) Treatment of recurrent aphthous stomatitis. A literature review. J Clin Exp Dent 6:e168–174CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Brocklehurst P, Tickle M, Glenny AM, Lewis MA, Pemberton MN, Taylor J, Walsh T, Riley P, Yates JM (2012) Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev 9:CD005411Google Scholar
  19. 19.
    Ship JA (1996) Recurrent aphthous stomatitis. An update. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 81:141–147CrossRefPubMedGoogle Scholar
  20. 20.
    Zand N, Ataie-Fashtami L, Djavid GE, Fateh M, Alinaghizadeh MR, Fatemi SM, Arbabi-Kalati F (2009) Relieving pain in minor aphthous stomatitis by a single session of non-thermal carbon dioxide laser irradiation. Lasers Med Sci 24:515–520CrossRefPubMedGoogle Scholar
  21. 21.
    Zand N, Fateh M, Ataie-Fashtami L, Djavid GE, Fatemi SM, Shirkavand A (2012) Promoting wound healing in minor recurrent aphthous stomatitis by non-thermal, non-ablative CO2 laser therapy: a pilot study. Photomed Laser Surg 30:719–723CrossRefPubMedGoogle Scholar
  22. 22.
    Prasad RS, Pai A (2013) Assessment of immediate pain relief with laser treatment in recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol 116:189–193CrossRefGoogle Scholar
  23. 23.
    Tezel A, Kara C, Balkaya V, Orbak R (2009) An evaluation of different treatments for recurrent aphthous stomatitis and patient perceptions: Nd:YAG laser versus medication. Photomed Laser Surg 27:101–106CrossRefPubMedGoogle Scholar
  24. 24.
    Aggarwal H, Singh MP, Nahar P, Mathur H, Gv S (2014) Efficacy of low-level laser therapy in treatment of recurrent aphthous ulcers—a sham controlled, split mouth follow up study. J Clin Diagn Res 8:218–221PubMedPubMedCentralGoogle Scholar
  25. 25.
    De Souza TO, Martins MA, Bussadori SK, Fernandes KP, Tanji EY, Mesquita-Ferrari RA, Martins MD (2010) Clinical evaluation of low-level laser treatment for recurring aphthous stomatitis. Photomed Laser Surg 28:S85–S88CrossRefGoogle Scholar
  26. 26.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12CrossRefPubMedGoogle Scholar
  27. 27.
    Salman H, Kashmoola MA, Al-Waiz MM, Al-Sandooq TA (2008) Differences between low level laser therapy and triamcinolone acetonide kenalog on healing of recurrent aphthous ulceration. Ann Coll Med 34:35–41Google Scholar
  28. 28.
    Hazeem MI, Rajab MS, Badeia RA (2013) Treatment of recurrent aphthous stomatitis with 940 nm diode laser. Tikrit J Dental Sci 1:77–82Google Scholar
  29. 29.
    Lalabonova H, Daskalov H (2014) Clinical assessment of the therapeutic effect of low-level laser therapy on chronic recurrent aphthous stomatitis. Biotechnol Biotechnol Equip 28:929–933CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Sattayut S, Trivibulwanich J, Pipithirunkarn N, Danvirutai N (2013) A clinical efficacy of using CO2 laser irradiating to transparent gel on aphthous stomatitis patients. Laser Ther 22:283–289CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Albrektson M, Hedström L, Bergh H (2014) Recurrent aphthous stomatitis and pain management with low-level laser therapy: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol 117:590–594CrossRefPubMedGoogle Scholar
  32. 32.
    Bornstein MM, Suter VG, Stauffer E, Buser D (2003) The CO2 laser in stomatology. Part 2. Schweiz Monatsschr Zahnmed 113:766–785 (in German, in French)PubMedGoogle Scholar
  33. 33.
    Suter VG, Altermatt HJ, Dietrich T, Warnakulasuriya S, Bornstein MM (2014) Pulsed versus continuous wave CO2 laser excisions of 100 oral fibrous hyperplasias: a randomized controlled clinical and histopathological study. Lasers Surg Med 46:396–404CrossRefPubMedGoogle Scholar
  34. 34.
    Carvalho PA, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA (2011) Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: a double-blind randomized study in head and neck cancer patients. Oral Oncol 47:1176–1181CrossRefPubMedGoogle Scholar
  35. 35.
    Doeuk C, Hersant B, Bosc R, Lange F, SidAhmed-Mezi M, Bouhassira J, Meningaud JP (2015) Current indications for low level laser treatment in maxillofacial surgery: a review. Br J Oral Maxillofac Surg 53:309–315CrossRefPubMedGoogle Scholar
  36. 36.
  37. 37.
    Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RA (2006) Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg 24:158–168CrossRefPubMedGoogle Scholar
  38. 38.
    Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR (2012) The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 40:516–533CrossRefPubMedGoogle Scholar
  39. 39.
    He WL, Yu FY, Li CJ, Pan J, Zhuang R, Duan PJ (2015) A systematic review and meta-analysis on the efficacy of low-level laser therapy in the management of complication after mandibular third molar surgery. Lasers Med Sci 30:1779–1788CrossRefPubMedGoogle Scholar
  40. 40.
    Miloro M, Halkias LE, Mallery S, Travers S, Rashid RG (2002) Low-level laser effect on neural regeneration in Gore-Tex tubes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93:27–34CrossRefPubMedGoogle Scholar
  41. 41.
    Enwemeka CS, Parker JC, Dowdy DS, Harkness EE, Sanford LE, Woodruff LD (2004) The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study. Photomed Laser Surg 22:323–329CrossRefPubMedGoogle Scholar
  42. 42.
    Vale FA, Moreira MS, de Almeida FC, Ramalho KM (2015) Low-level laser therapy in the treatment of recurrent aphthous ulcers: a systematic review. ScientificWorldJournal 2015:150412. doi: 10.1155/2015/150412 PubMedPubMedCentralGoogle Scholar
  43. 43.
    Greer RO Jr, Lindenmuth JE, Juarez T, Khandwala A (1993) A double-blind study of topically applied 5% amlexanox in the treatment of aphthous ulcers. J Oral Maxillofac Surg 51:243–248CrossRefPubMedGoogle Scholar
  44. 44.
    de Freitas LF, Hamblin MR (2016) Proposed mechanisms of photobiomodulation or low-level light therapy. IEEE J Sel Top Quantum Electron 22:348–364CrossRefGoogle Scholar
  45. 45.
    Mester E, Spiry T, Szende B, Tota JG (1971) Effect of laser rays on wound healing. Am J Surg 122:532–535CrossRefPubMedGoogle Scholar
  46. 46.
    Mester E, Nagylucskay S, Döklen A, Tisza S (1976) Laser stimulation of wound healing. Acta Chir Acad Sci Hung 17:49–55PubMedGoogle Scholar
  47. 47.
    Wagner VP, Meurer L, Martins MA, Danilevicz CK, Magnusson AS, Marques MM, Filho MS, Squarize CH, Martins MD (2013) Influence of different energy densities of laser phototherapy on oral wound healing. J Biomed Opt 18:128002. doi: 10.1117/1.JBO.18.12.128002 CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Pereira Tdos S, Silva Alves Jde F, Gomes CC, Rocha do Nascimento A, Stoianoff MA, Gomez RS (2014) Kinetics of oral colonization by Candida spp. during topical corticotherapy for oral lichen planus. J Oral Pathol Med 43:570–575CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2017

Authors and Affiliations

  • Valerie G. A. Suter
    • 1
  • Sophia Sjölund
    • 1
  • Michael M. Bornstein
    • 1
    • 2
  1. 1.Department of Oral Surgery and Stomatology, School of Dental MedicineUniversity of BernBernSwitzerland
  2. 2.Faculty of Dentistry, The University of Hong KongPrince Philip Dental HospitalHong KongChina

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